Manager, Pharmacy Experience and Access

Job description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. The Job This position will play a central role in designing, implementing, and overseeing the Part D program, including coverage determinations and appeals for a senior-focused Medicare Advantage Plan. The Manager will be responsible for ensuring CMS compliance, operational excellence, and enhanced member experience. The Manager will provide leadership, strategic direction, and oversight to the team while ensuring effective management of the contracted pharmacy benefit manager (PBM), including PBM performance, formulary operations, utilization management processes, and ongoing compliance requirements. You Will Lead and support CMS Part D program audits and data validation audits; manage audit universe files; including HPMS reporting requirements and ensure ongoing audit readiness through mock audits, compliance monitoring, and post-submission reviews. Lead the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs (DUR, FWA, Patient Safety Analysis, Opioids) for compliance and effectiveness. Ensure CDAG operations (e.g., coverage determinations and appeals) are timely and compliant with CMS’s regulations. Implement new CMS programs and process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending. Maintain up-to-date clinical policies and desktop procedures, ensuring internal adherence across clinical operations. Serve as subject matter expert for Part D coverage determinations and redeterminations. Stay current with Medicare Part D regulations by attending CMS calls and applying released guidance to maintain compliance. Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience. Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance. Oversee Formulary and Utilization Management and implementation. Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.) We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned. Your Qualifications Graduate or Advanced Degree, Pharm D required. Active Pharmacist License required. Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience preferred. Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required. 5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred. 1-2 years leadership/management experience strongly preferred. Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership. Leadership - Lead and inspire teams to achieve performance goals, offering guidance and support Problem Solving - Good problem-solving skills Communication - Good communication and interpersonal skills Strong analytical, problem-solving, and decision-making abilities - Ability to think strategically while executing tactically - Detail-oriented and highly adaptable to a fast-paced, evolving environment - Demonstrated ability to manage multiple priorities simultaneously Proven leadership, manager, and accountability skills - Strong organizational, time management, and project management capabilities - Self-starter with a resourceful and innovative mindset - Effective across cross-functional teams and collaborative environments Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions Communication & Professionalism - Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions What's in it for you? Base salary range: $147,900 to $214,030 per year. Work Mode: Remote An annual employee bonus program Robust Wellness Program Generous paid-time-off (PTO) 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday Excellent 401(k) Retirement Saving Plan with employer match and contribution Robust employee recognition program Tuition reimbursement An opportunity to become part of a team that makes a difference to our members and our community every day! We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now! At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-CS2 #LI-Hybrid Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)